Two dozen holdout states are still balking at expanding a federal program that would extend access to healthcare to more poor adults and ease the cost burden on providers who treat them.

There are 27 states that have accepted the federal government's offer to help pay for Medicaid expansion. The other 23 states, mostly politically "red" states across the South, Plains, and Rocky Mountains, are locked in partisan struggles over expanding the program.

The expansion of Medicaid to more poor adult Americans is a key component of the federal Patient Protection and Affordable Care Act. Medicaid expansion and the new federally spawned individual health insurance exchanges are designed to provide healthcare access to poor and low-income Americans, respectively.

Under the PPACA, most individual adults with incomes under 100 to 138 percent of the federal poverty level are eligible for health insurance coverage through Medicaid. The federal healthcare law allows most individuals with incomes from 138 to 400 percent of federal poverty level to purchase subsidized insurance policies on the new exchanges.

"It's a crime. These are the most vulnerable people in our society. They have no other access to healthcare," says Lisa Dubay, PhD, a researcher at The Urban Institute and co-author of a recent report on Medicaid expansion. "We have no way to take care of them and that just seems wrong."